Provider Demographics
NPI:1295254415
Name:FIZETTE, KRISTA R
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:R
Last Name:FIZETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHERRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:NY
Mailing Address - Zip Code:13797
Mailing Address - Country:US
Mailing Address - Phone:607-765-3163
Mailing Address - Fax:
Practice Address - Street 1:4104 VESTAL RD STE 101
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3500
Practice Address - Country:US
Practice Address - Phone:607-235-3980
Practice Address - Fax:607-235-3982
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist